The purpose of this study was to evaluate early results of a new as yet not described minimal invasive posterior gluteus maximus splitting approach for total hip arthroplasty (THA) and also metal on metal hip resurfacing.

A new minimal invasive gluteus maximus splitting posterior approach is described backed up with intra-operative videos. This single incision approach allowed THA to be carried out through an incision ranging from 5.5 cm. to 9 cm. and metal on metal (MOM) resurfacing through an incision ranging from 7.5 cm. to 10 cm. Intra-operative fluoroscopy is not needed. The patients were not selected according to body mass index (BMI). All patients are suitable for this approach except for severely obese patients. 30 patients underwent THA (both cemented and uncemented) and 20 underwent MOM resurfacing. Early results at average 6 months indicate low post-operative pain scores, low blood loss (less than 5% needing transfusion), early mobilisation and discharge from hospital. Patients also returned to normal activities early with excellent cosmetic results and high patient satisfaction scores. There were no complications.

THA and MOM hip resurfacing can safely be done through a minimally invasive gluteus maximus splitting approach with excellent early results without any complication

Introduction

A new surgical approach for minimally invasive hip resurfacing is described with early results.

The purpose of this study was to evaluate the early results of a new and minimally invasive posterior gluteus maximus splitting approach for total hip arthroplasty (THA) and metal-on-metal hip (MOM) resurfacing.

Thirty patients underwent THA (both cemented and uncemented) and 20 underwent MOM resurfacing. This single incision approach permitted THA through an incision ranging from 5.5 cm to 9 cm, and MOM resurfacing through an incision ranging from 7.5 cm to 10 cm. Intraoperative fluoroscopy was unnecessary. Body mass index was not a selection criterion. With the exception of the severely obese, this approach is suitable for all patients.

Fewer than 5% of patients needed blood transfusions. Patients were mobilised early and discharged from hospital. At a mean follow-up of six months, postoperative pain scores were low, cosmetic results excellent and patient satisfaction scores high. . Patients returned to normal activities early. There were no complications.

Eighty-seven feet have been reviewed after arthrodesis of the first metatarsophalangeal joint stabilised by chromic catgut. Radiological union was present in 90% of patients at the mean review time of six years. Twenty-four patients had significant metatarsalgia before operation and only two failed to improve afterwards. Excellent or good subjective results were reported in 94% of patients at review. Chromic catgut is advocated as a simple and effective method of stabilising an arthrodesis of the first metatarsophalangeal joint.